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一家三级医院中与毛霉菌病相关的手术及医疗并发症

Surgical and medical complications associated with mucormycosis in a tertiary hospital.

作者信息

Barrera-López Francisco J, Noyola-García Maura E, Barrera-López Natalia G, Albarrán-Sánchez Alejandra

机构信息

Servicio de Medicina Interna, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.

Centro de Investigación Biomédica de Occidente, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco. Mexico.

出版信息

Gac Med Mex. 2025;161(2):148-153. doi: 10.24875/GMM.M25000988.

Abstract

BACKGROUND

Mucormycosis is an infection caused by Mucorales. Management includes surgical treatment and antifungals.

OBJECTIVE

To describe the surgical and medical complications associated with mucormycosis in a third-level hospital.

MATERIAL AND METHODS

Records of patients with mucormycosis treated between 2019 and 2022 were collected.

RESULTS

A total of 25 patients were obtained, 17 (68%) men and 8 (32%) women. Surgical complications occurred on admission in 16% and early in 4% of cases. The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Amphotericin B deoxycholate was used in all cases, finding hypokalemia in 20 (80%), hypomagnesemia in 18 (72%), and acute kidney injury in 15 (60%).

CONCLUSIONS

The most commonly performed surgery was surgical debridement on admission (76%). Surgical complications occurred mainly on admission (16%). The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Due to the high cost of the liposomal and lipid forms of amphotericin, the use of amphotericin B deoxycholate continues to persist in our setting, which leads to a high degree of renal toxicity and hydroelectrolytic alterations.

摘要

背景

毛霉病是由毛霉目真菌引起的一种感染。治疗方法包括手术治疗和抗真菌治疗。

目的

描述一家三级医院中与毛霉病相关的手术和医疗并发症。

材料与方法

收集了2019年至2022年间接受治疗的毛霉病患者的记录。

结果

共纳入25例患者,其中男性17例(68%),女性8例(32%)。16%的病例在入院时发生手术并发症,4%的病例在早期发生手术并发症。最常见的医疗并发症是入院时软组织感染(84%)和晚期脓毒症(52%)。所有病例均使用了去氧胆酸两性霉素B,发现20例(80%)出现低钾血症,18例(72%)出现低镁血症,15例(60%)出现急性肾损伤。

结论

最常进行的手术是入院时的手术清创(76%)。手术并发症主要发生在入院时(16%)。最常见的医疗并发症是入院时软组织感染(84%)和晚期脓毒症(52%)。由于两性霉素脂质体和脂质剂型成本高昂,在我们的环境中去氧胆酸两性霉素B的使用仍然持续存在,这导致了高度的肾毒性和水电解质紊乱。

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